Akathisia vs Restless Leg Syndrome: What You Need to Know - Dr Sanil Rege Explains
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- Опубліковано 27 лип 2024
- Join us in this informative video to explore the intricate differences between Akathisia and Restless Leg Syndrome (RLS).
Consultant psychiatrist Dr Sanil Rege provides valuable insights into these often perplexing conditions, shedding light on their symptoms, treatments, and underlying mechanisms.
In this must-watch video, Dr Rege expertly guides you through the complexities of Akathisia and RLS. Discover how antipsychotic medications can trigger Akathisia and how this differs from the effects of SSRIs, which can also induce similar symptoms. Gain a comprehensive understanding of how these medications impact the body and learn effective strategies to manage associated side effects.
Time stamps:
0:10 Introduction to Akathisia
2:04 Patient’s clinical experience of akathisia
4:15 Chronic Akathisia
6:22 What are the medications that lead to akathisia?
8:31 The pathophysiology of Akathisia
10:59 The ventral striatum and nucleus accumbens.
13:20 Distinguishing between akathisia and restless leg syndrome.
16:12 How to reduce the dose?
18:06 Medications that modulate the dopaminergic system in the treatment of akathisia
19:23 Reduce dose and add anti-akathisia agents
#akathisia #antipsychotics #antipsychoticsideeffects
Akathisia is defined as :
Subjective complaints of restlessness, often accompanied by observed excessive movements (e.g. fidgety movements of the legs, rocking from foot to foot, pacing, inability to sit or stand still), developing within a few weeks of starting or raising the dosage of a medication (such as a neuroleptic) or after reducing the dosage of a medication used to treat extrapyramidal symptoms.
The pathophysiology of akathisia appears to be complex, involving several neurotransmitters, including dopamine, acetylcholine, y-aminobutyric acid (GABA), norepinephrine, serotonin, and neuropeptides.
The neurotransmitters most specifically linked to akathisia are gamma-aminobutyric acid (GABA) and serotonin. GABA (mainly via GABAA receptor interactions) exerts an influence on dopamine-dependent signalling, thus, increasing or reducing locomotor activity
One of the critical discussion points is the role of antipsychotic medications in causing Akathisia. We explore how these drugs may lead to this condition and how they differ from SSRIs, which can also induce Akathisia.
Not only does this video address the symptoms and treatments of Akathisia, but it also breaks down the key differences between Restless legs versus Akathisia. Both conditions can cause discomfort and distress, but knowing the distinction can be vital for accurate diagnosis and effective treatment.
Akathisia may result from efforts to compensate for dopaminergic underactivity in the nucleus accumbens
Strategies for management include:
1. Reduce dose
2. Switch to low-risk antipsychotic
3. Adjunctive approaches:
Propranolol 40-80 mg/day
5HT2A receptor antagonists (e.g. mirtazapine 15 mg PO daily, cyproheptadine 8-16 mg PO daily)
Benzodiazepines (e.g. clonazepam 0.5-1 mg PO daily, diazepam 5-15 mg PO daily)
Anticholinergics (e.g. benztropine 1-4 mg PO daily) should be used mainly for patients who have concurrent Parkinsonism
An algorithm is also covered.
#AkathisiaInsights
#RestlessLegSyndrome
#ClinicalDifferentiation
#MedicalProfessionals
#PsychiatricInsights
#Pathophysiology
#Pharmacotherapy
#TherapeuticInterventions
This side effect is torture. They told me I would be tired and gain weight and lose my sex drive but nobody ever said I would be needing to jump out of bed every 5 seconds to pace the room. And I had a light case. You have no idea what this is like until you have it. I am on several mental health groups on facebook and I see way more people talking about suicide and some who actually do it on the akathisia group then on any of the others combined. If doctors had to suffer these side effects there would be a massive revolution in how mental illness is treated.
Yes it is a very distressing side effect which is associated with a high risk of suicide. Thank you for sharing your Personal experience
Why do you give yourself credit when you never helped anyone not suffer or stop suffering? Are you a hero?
i am sure now lots of them mass shootings ocured because of it.
@@laurieberry4814 That is no a nice question. That person just wanted to share their own experience. So please don be rude.
I stopped taking all my psychiatric meds because of akathisia. I learned coping skills through some very fine therapists who specialized in CBT, DBT, ACT, and Mindfulness. The counseling and group therapy provided by them helped me far more than the meds ever did. Still to this day I use the "Check The Facts" DBT skill to unravel delusional thinking. DBT was not originally meant for schizoaffective disorder, but I swear by it. It is very helpful for me. Mindfulness is also very helpful. Remember, "Thoughts Are NOT Facts."
I have had this for over 7 months and it's been absolute hell, i dont know if i will survive this and i dont know how i have survived it this long, i feel like i'm possesed and i was NOT mentally ill before they put me on SSRIs. Now i survive in a state of abject panic and terror, i have constant suicidal thoughts, that were not there before and drive me mad. I've developed intolerances to food, food supplements and all chemicals because they ramp up all the physical and mental suffering. On top of all of this i have am surrounded by medical professionals (that caused this) that dont believe me and think i am mentally ill which i am not. I am chemically damaged and was drugged into insanity for a condition i never suffered from in the first place and i get looked at in disgust when i am now honest with my doctor and the psychiatric people i have to deal with to get through this. I dont care what they think of me, this should be illegal, it is an inhumane torture that i cant even explain. I'm so damaged and i cant believe people get to do this and aren't held accountable. I feel like im dead, i keep going on blind faith that time is a healer because no doctor or psychiatrist is helping me. Tragic! I hope all the doctors get this for a year, they will change their minds, trust me! I would like an apology for my life being destroyed from SOMEONE but apparently even that is asking too much.
How long were you on the ssri
Hang in there Karen I know that's easier said than done but believe me you can and will get through this I went through everything you have described Drs didn't help with them it was try another med I refused for me it was time I had to change how I ate I eventually saw a Chiropractor who muscle tested me for the proper supplements and again time, honey time, which I didn't want to do 1 more second,minute,hour,day,week let alone a month with akathesia when I realised it, it was all I had the support of groups of people on YT also helped which at the time I had no idea anyone else was going through it. I prayed daily it showed me I had the will to get through the moment take baby steps drink plenty of water to flush out the toxins. There is supplement made by Standard Process called Min- Tran I take it helps to relax, magnesium also helps to relax if you take to many you'll have a loose stool effect which helps to be the judge on how much you should take, I hope this helps it going to get better.💜
@@sandrahbradley1511 Karen committed suicide 😢
I’m so sorry Karen , you didn’t deserve this RIP. 🙏 When in the hell will the medical community WAKE UP and stop prescribing these poisons!!!
@@valeriezushin9419 did she really?! 😢
It’s so much more than just movement!!
🎯🎯🎯. The internal akathisia is what kills. It pushes people to suicide and is also thought to be at least part of the reason for violence and homicidality.
SSRIs, the only drugs that kill people who never took them.
Yes! I don’t think I’ve ever heard any doctor speak about the feelings of dread, fear, dysphoria, and anxiety you experience. I’ve told doctors about it and they seem to believe that akithisia solely has to do with restlessness.
It sounds counter-intuitive, but with my first VERY intense experience of akathesia I was so distressed (almost disturbed) that I had an urge to douse myself in petrol and set myself alight, for RELIEF of the suffering- which makes no sense to me now, since it would have only added to the suffering. There is a profound terror that comes with the physical symptoms, which is nothing like psychiatric anxiety or panic. It’s chemical. That terror was a different animal altogether. I still have it, but not to the extent of my initial onset of symptoms. Doctors keep wanting to put it down to psyche symptoms of agitation and panic but it simply isn’t. I have experienced GAD and panic disorder and can calm those symptoms, ie with meditation and mindfulness. This chemically induced terror can NOT be relieved that way.
Sorry to hear. Akathisia is an extremely distressing side effect and is associated with an increased risk of suicide. Thank you for sharing - it sounds like a horrific experience.
You have left one of the biggest most painful parts of akathisia out. Why did you not include the terror that one experiences with akathisia? I am 15 months off of all benzos and antipsychotics and still suferring with a need to move because if horrible sensations in my legs. But I am also experiencing a feeling of absolute terror and impending doom. .... It makes me scream and cry all the time. Why did u leave the terror out. You can find it listed as a part of Akathisia in many many different sources. I hope you will explain.
Sorry to.hear. We have covered akathisia as a - not kathizen - sit still. This is the definition required for diagnosis - which is linked to a subjective or objective compulsion to move. Most certainly it can be associated with a range of emotional and cognitive symptoms - with terror, depression, agitation etc being some of them.
@@PsychiatrySimplified Until you have experienced this yourself - you have absolutely no idea what you are talking about and you really should not speak on it from a position of ignorance.
Mom and daughters how r u now
@@PsychiatrySimplified It’s more like something took over your body and soul!!
@@THXx1138 how are you doing now
Dr Rege. Here’s a great suggestion. Don’t give medicine that causes it against someone’s will because a family member can’t shut up about your patient.
And give FULL AND COMPLETE Informed Consent!
I stopped pregabalin 4 years ago and have had akathisia since and it is the most horrific thing I could never have imagined - it is truly terrible. Pregabalin has caused irreparable damage and akathisia is just torture yet most Doctors refuse to believe the damage that pregabalin has caused and just refuse to discuss it so they keep prescribing it to others.
Sorry to hear. Hope you can get help.
@@PsychiatrySimplified There is no professional help, only ridicule and avoidance.
They did the damage but don't want to know. And it gave me brain aneurysms.
I had that reaction with Reglan...I wouldn't wish it on my worst enemy. No matter what I did I couldn't get right...I paced and skipped, my body wanted to jump out of my skin! If I had been near a bridge, I would have jumped off.
Hi Dr. Sanil Rege.
Would you be willing to make a video explaining the psychological components to Akathisia? The severe fear, dissociation, anger, crying spells, self harm, etc... And the physical nerve pain that's involved in it? The nerve pain is beyond comprehension. A scientific description of how and why these things are happening would be really helpful. I know the research is limited but if there's any information that could be shared to explain it further, I believe it could help a lot of people.
Thank you for your consideration and educational contributions.
Thank you for that suggestion. Will keep that in mind. You are right - there is not much literature on this.
@@PsychiatrySimplified Thank you so much. I really appreciate it.
Hopefully one day there will be more research.
It's just a matter of time at this point until more is documented as far as I can tell. People in the Akathisia support groups are showing very specific psychological and physical symptoms. Most of which I'm able to relate to since I have the condition as well. It took me a long time to get diagnosed because of the lack of awareness of those symptoms combined with movement or the urge to move.
@@BrandonsHealthJourney if you can direct me to some support groups so I can read comments that would help. Thanks
@@PsychiatrySimplified I typed up quite a comment but it looks like it might not have gotten through because of adding links. On my side it looks like the comment may not have gotten approved.
There are two groups in particular that have quite a lot of people in them.
Living with akathisia
Akathisia - essential family and caregiver.
Living with akathisia has quite a few videos of people in Akathisia and lots of testimonies describing symptoms. Very hard to watch videos.
Hopefully the caregiver group would be open to you joining to learn more. They describe symptoms thoroughly in there.
There are also two organizations that may be worth looking into.
Akathisia alliance for education and research.
And MISSD.
@@BrandonsHealthJourney I can't find a comment waiting to be approved. thanks for the suggestions. I've watched one's on YT thanks. He's very very distressing symptom.
How can you justify being part of a profession that does this to people? You make me absolutely sick to my stomach.
Ikr
The academic community needs to come up with a new word for the unpleasant feeling associated with akathisia and restless leg syndrome. It is NOT paresthesia. Thats a misinterpretation of patient description. “Inner restlessness” is wrong too, as that gives the impression it is an emotional state. Its definitely a physical sensation, but its not “pins and needles”. Its more of a steady vague itch or pain deep in the skeletal muscle or bone. Its “vague” as in the location is diffuse and hard to pinpoint. That doesn’t mean it isn’t intense. Its diffuse in the way nausea is diffuse. Nausea vaguely emanates from the stomach area, but it isn’t a pinpoint sensation like a normal physical pain or itch.
I don’t know if everyone senses it this way, but for me when it is on the milder end I first sense it as a kind of phantom vibration in my left hand. I feel as though I have a tremor, even though there is no physical tremor.
Thank you for your thoughts. you raise many good points. In clinical practice understanding patient descriptions as best as possible Often tends to be better than a broad label. No different to the term depression not encompassing all the patient descriptions. Thanks again
@@PsychiatrySimplified The problem I have is diagnosing based on behavior alone does disservice to patients with a milder but still very uncomfortable version of this phenomena. I experienced mild akathisia from SSRI’s in the 1990s and it was frustrating trying to explain that what I was experiencing was not simple anxiety. Akathisia was dismissed because I could sit still. Its true that emotional states can be interpreted as sensations, but when a patient expresses that what they are feeling is something novel (not like anything they experienced before taking such a medication) they need to be taken seriously. Misinterpreting odd complaints as merely a symptom of an underlying condition to be treated by increasing the dose or adding other medications could be disastrous. Since akathisia is such a torturous experience that can lead to suicide attempts or violent behavior, even the mildest suspicion should be an indication to reduce or discontinuing the medication to see if the symptom improves.
Adding more medications in my experience made things much worse as at that point its impossible to know what is causing what. The combination of sertraline and clonazepam was particularly traumatic to me because there was an unpredictability to the symptoms. My experience was that the clonazepam would eliminate the akathisia sensation during the first 6 hours or so, but there would be an extreme and somewhat unpredictable rebound. It was hard tell if the extreme restlessness was a paradoxical effect of the clonazepam, or if my body was metabolizing it much more quickly than normal and the sertraline side effect was rebounding as the clonazapam wore off. It was confusing as adding clonazepam seemed to make the akathisia much worse with the way it interacted with the SSRI. Rather than a steady side effect it came in sudden horrible attacks where I wanted to throw myself out of a window.
Anyways, this is the reason I think there is a need to pay close attention to patient descriptions, even if they are less objectively observable. Akathisia has to become severe to reach the point where one cannot remain still, but that doesn’t mean it wasn’t present before. The beginning stage doesn’t always lead to uncontrollable movement. It can be just an unpleasant sensation.
I take Gabapentin and when I try to quit I get Akathisia. It is utterly unbearable. Within one hour of taking Gabapentin again all the symptoms go away completely. My problem is Gabapentin is now causing me to lose short term memory which means I have been let go from two jobs I had. My employers just bullied me as they thought I just didn't care about my work.
I hope it worked out for you. I seen a man on UA-cam that had is severely and he used medical weed to stop his symptoms
I found out that venlafaxine stopped the akathisia
YESSS!!!!! MEDICAL MARIJUANA IS KEY TO STOP AKATHISIA AND LITTLE BY LITTLE STOP TAKING THE PILLS THAT CAUSED THIS! THERE'S ALWAYS HOPE. I HAVE HAD AKATHISIA AND YES THERE'S HOPE, YOU'LL BE STRONG LIKE NEVER BEFORE AND ACCOMPLISHED WHAT NEVER BEFORE
Ropinorole works
I mean if you can't do your job they have to let you go. It's not bullying. Still sad though.
The medical definition itself downplays the immense suffering people suffering from akathesia experience. All drugs have side effects but drugs that cause you to have side effects which are much more likely to drive you to suicide than the disease it is supposed to manage is likely not beneficial to the patient. And psychiatrists never warn the patient as to how much they will suffer if they get this condition. The entire branch of psychiatry needs to rethink its treatment methods because its like you are trading one disease for an even more painful, unbearable disease. Your hallucinations is under control but you feel like your spine will rip out of your back and then suffer from insomnia induced hallucinations.
Unfortunately, psychiatrists and other mental health providers will never admit that and continue to believe that developing debilitating side effects like akathisia, dystonia and parkinsonism are an acceptable tradeoff when it comes to treating severe mental illness.
If you have ever experienced this. You would you know.
I have experienced it around 4 or 5 times in my life (no more then an hour or so each time)
I’ve likely never experienced anything else as unpleasant or unbearable.
I would describe it as an intense physical ‘Whole body’ Anxiety, including but not limited to sensations and emotions of panic, terror and even paranoia.
Basically the practically continuous state of Fight and Flight / experienced at the same time.
Deep and slow breathing and mindfulness techniques provides some basic relief, until typically the sensations / symptoms and associated panic begin to pass within around 45 to 90 minutes.
We need more attention on these side effects..
Thank you! Very instructive and clear! I also appreciate the opinions and experiences shared in the comments. Tricky and hard to alleviate... I will think twice before prescribing and make sure to inform my patients of this side effect as well. I tend to discuss the most frequent side effects to convince patients to adhere to a medication, but now i think honesty and transparency is better than manipulating someone into a better state of mind
Stop handing out psych meds like candy and make them schedule 1 drugs where they belong
Schedule 1 denotes lack of therapeutic uses.
I have it and mine was caused from benzo withdrawal! It’s absolute hell and most Dr’s are clueless.
I have it from benzo withdrawal how are you now
Really good video, thanks.
Incorrect on the part where Akathisia doesn’t cause insomnia.
Akathisia is associated with insomnia but is not a core feature - I presume this was mentioned compared to RLS, which can be misdiagnosed where insomnia is often present due to PLMS.
@@PsychiatrySimplified you have no clue what you’re talking about until you experience it.
@@valeriezushin9419 He’s an emotionless and apathetic psychiatrist. Get used to it. They’re all the scum of the earth.
Definitely causes insomnia
Agreed. All I know who have had Akathisia had extreme insomnia and pacing in the middle of the night. 😢
Unfortunately I know a lot more about Akathesia than I would like. Akathesia is beyond HORRIBLE! I was given something called DROPERIDOL when i went to the ER for nausea and vomiting. It made me basically start convulsing on the bed and fast-forward I kept having to go back to the ER to get the Akathesia treated and it wouldn't work. Id have to pace 100% of the time for 7 hours at a clip bc of the wait-times. My body and hips were exhausted and my thighs would be burning. They kept giving me Propranolol and it would only take edge off slightly. So now on top of what would be diagnosed 5 months later as 2 bleeding ulcers, Pylori, SIBO, IMO, gallstones/Pancreatitis.....I had to deal with ungodly Akathesia. I've had RLS and Akathesia and Akathesia blows RLS out of the water. Interestingly enough, though....when I got on different antibiotics for all of my infections, the severe brain fog and Akathisia and RLS went away pretty much immediately. I don't understand that. But yes, it definitely was Akathesia i was going thru. Ive had it a few times before unfortunately. Im super susceptible to it. But the GI doc i went to said he has never heard of giving DROPERIDOL (antipsychotic) for nausea. I finally found info that it is, but extremely uncommon. Nightmare I went thru. I actually have PTSD from it.
That sounds distressing. Sorry to hear and thanks for sharing. Droperidol can definitely do this. Do you have iron deficiency? As individuals with significant iron deficiency can have significant side effects to D2 antagonists / antipsychotics. Hope you have been treated for it?
@PsychiatrySimplified HI! So on 8/5/23 my Primary Care doctor did a panel including iron. No one called me with the results so I looked for myself on something called "mychart."
It reads:
Iron- 21
Total Iron Binding Capacity- 638
Iron Saturation- 5
So that's that. I have a feeling my body isnt absorbing nutrients well. My Magnesium is very low and so is Vitamin D. Maybe due to the SIBO/IMO and Grade 3 Abnormal (severe gastroparesis). SIBO is small bowl where nutrients are absorbed. My doctors will do these tests and i will NEVER hear from them again if I dont chase them down. Even then, it's a struggle. Ever since i got sick eith stomach stuff, Its like I almost have the actual Akathesia. Its like the tip of it and enough to make me uncomfortable a lot. But no doctor.....i mean none...understand it. That is including a therapist I consulted. I just want to put them in an ER bed and pump them with Regalan just to get someone who understands the insane fight flight freeze. But i wouldnt do that. Wouldn't wish it on anyone. Thank you for the response. That was really cool. I tend to veer off track. Sorry about that. But I really could talk about my Akathesia experiences down to the second. The hardest part isn't the incessant pacing....it's what it makes your brain feel like. Horrid.
Great presentation
A useful education video
Thank you for the feedback 🙏🏻
For anyone suffering, please tell your dr. To give you dopamine agonists, it somewhat helps me while im waiting to see a neurologist. I have had akathisia for severalbmonths now and dopamine is somewhat helping.😢
Excellent videos as always.
Thank you for the feedback 🙏
There is a scale. Called the Barnes scale. 1 to 10. They will have you believe in something called agitated depression. Which blames the patient. I warned them about what would happen. Now my mum is dead and I have complex ptsd.
Sorry to hear. Yes the barnes akathisia scale. It is important to differentiate between medication indicted akathisia and agitated depression. Sorry for your loss. Hope you can get help for yourself. Wish you well.
From your response I can see that you paid no attention to that one lecture regarding mood disorders. SSRI's will cause Anesthesia.
@@davidbernardleevuchich3426 We have done a video on emotional blunting and SSRI sexual dysfunction where we discuss this anaesthesia aspect. ua-cam.com/video/345gEKz6kLQ/v-deo.html
Sanil,
Is there a norepinephrine component to akathisia? In an akathisia induced state, is dopamine low and norepinephrine high? Is serotonin off balance as well?
I’ve covered it in this video but you are correct NA is one component in two separate parts of NAc How to Diagnose and Treat Akathisia (Antipsychotic Side Effect) - A Consultant Psychiatrist Explains
ua-cam.com/video/GBSTgSaLUsg/v-deo.html
What about treatment for benzodiazepine withdrawal induced akathisia? Can amantadine be helpful as an NMDA antagonist to offset benzo-induced glutamate hyperactivity?
It’s a good question but difficult to answer. It depends on the clinical picture. The withdrawal sets off a cascade which can involve other neurotransmitters. Prominently noradrenaline. As in alcohol withdrawal, opioid withdrawal etc. and this NA Is linked to akathisia. Amantadine also releases NA & Dopamine
Prof Jordan Petersen is an interesting case with regards to Akathisia.
You neglect to mention akathisia due to discontinuation of neuroleptics, or reduction of blockade amount due to a medication change. This doesn't as easily fit into the paradigm mentioned, but it is very much a thing.
Is it possible that this might be due to changes in blockade of presynaptic receptors, actually decreasing DA efflux?
Yes good point - this video I covered only the effects of AP as side effects. But withdrawal akathisia is also very much a clinical issue. This is more likely to be due to a combination of multiple neurotransmitter withdrawals - anti histaminergic , anticholinergic etc. I’ve written about this in detail here psychscenehub.com/psychinsights/antipsychotic-withdrawal-syndrome-tapering/
My idea is not to put people on medicine that causes akesthesia in the first place.
I agree.
I agree, too. There should at least be informed consent. They never warned me about the possibility of getting akathisia from taking Geodon. Had I known, I would have tried counseling and group therapy using CBT, DBT, and Mindfulness before the last resort of meds. Counseling and group therapy helped me far more than the medication ever did. I stopped taking Geodon over five years ago and I have not been hospitalized since then. Some patients could benefit from counseling and group therapy and it is rarely offered to them. Especially the kind with skilled therapists who are trained in CBT and DBT and Mindfulness.
No kidding. What an insanely evil profession psychiatry is. Shame on this piece of trash ‘doctor’.
@@andy-np2od Did your akathisia go away?
@@jacob2431992 Yes, it took several months for it to completely go away, after I stopped taking Geodon.
The urge to continue moving is actually a horrible pain throughout the body that increases with less movement. It feels like having burning poison ivy on the INSIDE of your body.
It is a horrendous side effect and is the reason why it is associated with a high risk of suicide .
@@PsychiatrySimplifiedhell on earth. But they never warn when prescribing meds.
I found that Benadryl works great to help my severe Akathisia from Latuda, even though I'm already taking a Benzo and a beta-blocker. IT wasn't until I added 15mg of Benadryl that the symptoms became manageable.
Thanks for sharing. diphenhydramine ( Benadryl) also acts as an antimuscarinic; it is a competitive antagonist of muscarinic acetylcholine receptor and therefore used as an antiparkinson medication which in this case can also help akathisia.
Can the odd Occasional drug eg cocaine use cause these conditions? I have been experiencing muscle twitching, muscle internal vibrations in muscles, itchy tingling sensations in legs mostly, sometimes body jerks from the sensation of needing to move body, I’ve had most medical tests ruled out and been told is it anxiety based.
While we can’t give direct medical advice - stimulants such as cocaine can lead to akathisia.
Thanks!
Thank you for your support
I'm having this feeling like the lower half of my body is vibrating mostly around my upper thigh to lower abdomen area. I also feel it when I 1st wake up in my lower chest area and then it kinda moves down.
Sorry to hear. Please discuss this with your doctor as it is a challenging area. Hope all goes well for you.
I have exactly the same thing after an anti nausea injection a week ago, how are you doing now?
@@goat2503 I a little better I guess. I think I'm going through adrenal fatigue/stress. I have been super stressed lately, so I'm trying to deal with that. Thanks for asking. :-)
@@Biglover29 That symptom you describe, albeit very uncomfortable is not akathisia.
Akathisia symptoms
Restlessness in body
Urge to move legs or walk
Nightmares
Negative suicidal thoughts
Crying profusely
Limited range of motion
Unable to straighten arms
Feeling of lying in a grave when lying on bed
Extreme blurred vision
Dr Rege,
Is high dose Mirapex or Bupropion useful in akathisia with 15mg Mirtazapine if patient exhibits anxiety, moderate depression as well as akathisia, particularly with serotonin drugs or antipsychotics? Maybe add on low dose dexamphetamine if still required for antidepressant effect? Is this combination safe however?
Does research from Parkinson's Disease help with understanding akathisia and how to treat it?
B12, half RDI iron and magnesium, RDI B6, organic low pesticide diet important regardless of bloods all being within normal range is what I have found. Test each seperately for tolerance Excess serotonin containing foods, animal fat, fish oil, folates, b6, zinc and vit D3/calcium appear to worsen akathisia too.
Patients need to try and remain positive as the fear of never recovering likely increases limbic activation leading to a protracted recovery. Acetylcholine excess from cns activation? vs low dopamine. Also important they find goal directed activities to help increase dopamine. All easier said than done when experiencing severe akathisia. Why some treatment to take it down to a manageable level is sometimes necessary.
Thank you
Mirtazapine 15-30 mg is evidence based in the treatment of akathisia. Bupropion does not. A lot of akathisia is due to noradrenergic stimulation. Bupropion is a cyp2D6 inhibitor and increases levels of dexamphetamine so caution is required.
If you aren't familiar with Christy Huff, MD, I encourage you to read her story.
God these meds it is so hard to change and find the right combo. Is there a website that may help?
I have aka from Pregablin, nobody believes me ! They have given me a benzo to help ! So lost not sure where to go for help ? Any insight would be helpful.
Sorry to hear. Are you still on pregabalin? Or have they replaced it with benzo. Did the akathisia start after stopping pregabalin?
Min was tamed by benzos but now i am concerned avout the benzos
I was given IV compazine over 24 hours ago in the ER for nausea and almost immediately agitated and restless to the point I had to walk back and forth the ER hallway probably looked fucking crazy. It's over 24 hours later and I'm still walking circles around the coffee table in the living room. My legs feel like they are burning if I don't CONSTANTLY keep moving its INFURIATING WHEN WILL THIS END!?!
Sorry to hear - being a dopamine antagonist it can lead to akathisia. Hope you get relief - please see a doctor for treatment
Hope you are doing better. ❤
Has your Akathisia gone away? How did you know so quickly what it was?
Has it gone away?
Can Mirtazapine be used successfully in persistent SSRI withdrawal akathisia? Or is that just for antipsychotic induced?
It can be worth a trial - it’s difficult to know how successful it can be. Persistent SSRI withdrawal akathisia needs to be differentiated from agitation / hyperarousal as the mechanism of SSRI withdrawal morphs from being non-Serotonergic to noradrenergic and dopaminergic activation. This is identified based on history so the clinician can take a history then develop a hypothesis and then decide on the most appropriate agent to use.
This new video may help ua-cam.com/video/UoS9WX83DIs/v-deo.htmlsi=FaElgxE_9hkghlrB
Mine got so bad on Abilify I cut myself. not to commit suiside... But to make it stop. Ended up in ER. It's real!!!
Sorry to hear. Yes, akathisia is a terrible side effect. Hope you are better.
@@PsychiatrySimplified That is so Kind! Yes I'm better...
Tell me please your Akathesia started immediately after taking Abilify or after withdrawal. And how long did you take Abilify?
Yes please explain the story of your journey with this
Can this happen due to an edible (thc)?
Does this have similar patophysiology to ADHD? ADHD is also associated with low dopamine and restlessness, just much less pronounced.
In terms of hyperactivity associated with striatal compensation to reduced DA - yes in a way. Although Akathisia is medication induced and there are other mechanisms involved. Hence the treatment of different for the two.
Have this now. It is hell on earth. From Vraylar. Going off this med because of it.
Sorry to hear. It is a very distressing side effect. Hope things are better
Are you better now?
Do tell how you are!
My family are mean to me. They say nasty things with no empathy. They blamed me on anything bad. My sister only says negative things about me. She needs to be silenced for refusing to listen. I have akesthesia for many years. Thirty. This man is crazy for not telling us that akesthesia is permanent. He doesn’t have it. That is why he is lying out of his teeth. He must have cheated in college to become a doctor. He doesn’t talk about how bad it really is. It is worse than he says.
I don’t like this man. I don’t trust him and no one should. Let’s put this guy who calls himself a doctor on medicine that will ruin his life.
@@laurieberry4814 Right there with you Laurie. These con men are dangerous and are harming people left and right - all the while believing they are 'helping' people. Psychopaths.
I’m going to try to fast for 10 days with water and detox teas only, if I don’t feel normal again I’m done with all this bs
Some good info but also some not so good... the comparison to RLS was an absolute joke and I would like to know who came up with that. As far as treatments go, clonidine was the only thing that even phased it for me and it didn't require a high dose. In fact, a higher dose did nothing but cause side effects. All it took for me was 0.01mg at night which allowed me to sleep and recuperate some. Benzos can work but also can make it many times worse and with aka, once it is made worse, simply removing the drug doesn't always fix the problem. Same with gabapentin and remeron. These both made me much worse. I got better with just clonidine and eventually was able to stop that. Most other meds all made me worse the more I tried, except propranolol which helped for a short time then stopped doing anything.
Thank you for sharing your personal experience. The severity of akathsia varies and it is not uncommon for akathisia to be misdiagnosed as RLS hence the differentiating points. Clonidine is a useful agent. Thank you for your insights. Very helpful
@@PsychiatrySimplified sure. I can understand that.. but some of the criteria in the comparison was just straight wrong. Absent sleep disturbances with aka? What? I and every other person I ever talked to that went through it didn't sleep for days at a time and when we did, we had very disturbed sleep. RLS just makes it more difficult to fall asleep but sleep is still totally possible. That's just one thing about it.. almost everything on that list was wrong. Maybe there's some ultra mild form of akathisia that I'm unaware of but if that's the case, I highly doubt that's what anyone is talking about when they mention the disorder.
@@sk8n854 There is no such thing as 'mild akathisia'. You and I both know this. "Mild torture" doesn't exist.
Im starting to think i have akathisia!! My whole body is tingling n feels like on fyir n i wanna scream n feel like i uhae to kmove but im at hospital so I can't. How do ik if i uave ut for sure?? Its making m wanna scream.. eo i have it??😔
Ofcourse it’s not possible to comment on this on YT. The description could be one of akathisia or agitation. Have a listen to the video on anxiety vs hyperarousal vs agitation.
What if you’ve gotten this from an SSRI taper? Subsequent Updose didn’t really help. Benzos help in a pinch but that’s not viable long term solution. SSRI use, same SSRI, for 20 years. Awful. Going on 19 months of intense inner restlessness.
SSRI taper can result in REM sleep rebound - which can increase Noradrenergic levels this triggering akathisia ( mediated by NA). Dose increase after reduction initially increases NA - this a vicious cycle can be created . Summary SSRI ⬇️ - ⬆️NA - discuss arousal reduction meds with the doctor. pS not advice . Hope this helps.
Thank you, but what is an arousal reduction med? And why would akathisia still be present many months after a dose change of SSRI, withdrawal or increase, if it’s just temporary? Does NA increase on withdrawal and increase?
Would the same meds be used for SSRI withdrawal akathisia? Are there any that you mentioned that you would not recommend for SSRI withdrawal akathisia? specifically Mirtazapine? Doesn’t mirtazapine increase NA? What about Guanfacine? I have hear a lot of anecdotal evidence that guanfacine works, which I assume is because it’s similar to clonodine.
In theory, is it possible for the brain to re-regulate on its own if akathisia was induced by withdrawal? Perhaps by using exercise to try to regulate NA?
Thank you so much for answering our questions!! Most doctors don’t seem to understand the mechanism
What about looking term lithium use
Hi, I just wanted to point out that first generation anti-histamines can also worsen this. I’m on mirtazapine which is an anti histamine aswell as a atypical antidepressant, and it makes me go close to insanity at points in the night. Only thing I can do to help the symptoms are using kratom. I wouldn’t suggest anyone start using this if you can go without, but if it is really bad, taking kratom moderately can honestly be life saving
Mirtazapine is notorious for RLS - 28% incidence - RLS is usually time specific and closer to end of day. Kratom is helping because of Dopaminergic potentiation. This may indicate a vulnerability to RLS - Iron deficiency and DA deficit. Consider an evaluation for RLS which can be Comorbid with ADHD and other conditions where DA potentiation is needed . Ps not medical advice
I remember reading that Mirtazapine is considered to be a medication which can help ease restless leg syndrome (at a low dose). But it's one of the few medications I've taken that actively induced it in me. The other two were Quetiapine and Promethazine. The common thread is antihistaminergic activity.
Quetiapine is the other known one for RLS - both Mirtazapine and quetiapine have Noradrenergic potentiation - in some this effect may be prominent even at low doses which could lead to RLS. But the antihistaminergic effect is likely the more prominent issue.
NAC n acytel cysteine, look it up, will help this.
We have a playlist on NAC on this channel. Thanks for your comment. It hasn't been evidence based for akathisia but that's not to say it may not work.
Here it is N-Acetylcysteine in Psychiatry
ua-cam.com/play/PLV0KZkVDyoOEV_dfQN9oXce63ppD8XK7p.html
What do you think happened with Jordan B. Peterson, who was (allegedly) diagnosed with Akathisia last year. An interview with the Times in which he talks about this is on his yt-channel. It must certainly be an interesting case, seeing as the Benzodiazopenes were perhaps not treating him at all.
While it's difficult to comment on specific individual without examining them; benzodiazepine withdrawal can result in akathisia. As in the video one of the mechanisms is related to GABA ; so a BZd withdrawal results in a hypogabaergic state which can be associated with akathisia.
@@PsychiatrySimplified Thanks. Besides, Peterson was prescribed BZD for long periods at a time and took them for many months. In your video, you mention that BZD should not be taken for much longer than a month. Could a long and excessive intake of BZD induce suicidal thoughts he explains he had or are these thoughts a symptom of Akathisia?
@@samuelbosman9572 very difficult to answer those questions. This requires a history, examination and formulation to understand what are the possible hypothesis. There are too many variables. BZDs can be prescribed for a range of reasons. Any cessation of medication can result in rebound withdrawal; cessation withdrawal, persistent withdrawal, relapse or recurrence of illness. Very difficult to know which one it is without examination.
@@PsychiatrySimplified Ah, really? Very interesting that such cases can require such thorough examination so quickly. I am not even studying medicine yet, but have taken a great interest in the subject and in psychology as well. Your video has helped me understand a little bit about akathisia and I believe your explanation must be even more meaningful to those who have the basic knowledge of medicine. Basically, I can't wait to get studying, haha.
@@samuelbosman9572 good luck with studies. You may find the video on formulation and management useful that provides an insight into how a psychiatrist should think. ua-cam.com/video/XG4dotzDCeU/v-deo.html
Gabapentin did not do anything for me. Getting off drugs did it, but it took a month.
Reduce dose or cease ( only if not indicated ) - treatments, switching are other options
I stopped mirtazapine because it made me gain weight it’s only been a few days I think I have this I can’t still my whole body is agitated my mind is agitated I can’t focus on anything talking to people irritates me just sitting irritates me I have awful hallucinations at night spiders blood going down the wall the wall moving I can’t focus my mind feels so so full of impending doom for no reason
You may want to see this video as what you describe may be agitation, mirtazapine may not be able to target this. Why it’s SO IMPORTANT to know the difference between Anxiety vs Hyperarousal vs. agitation
ua-cam.com/video/UoS9WX83DIs/v-deo.html
I have both Akathisia and RLS. There’s no sleep disturbances with Akathisia?? There is no “low risk” antipsychotic. Yeah, the Benzos are band aids. What happens when you want to come OFF the Benzos?? Oh Jesus and you’re advocating for Gabapentin for Akathisia?? It doesn’t work!!
Every doc & every cop needs to be cuffed & brought to justice for my 7 years of forced Akathisia torture! There is nothing else...
How did that happen you have aka for 7!yrs now
How are you now
2-4 weeks the Akathisia goes away on a Benzo?? What are you supposed to do when you’ve been ripped off a Benzo?? And Clonidine?? Yeah tried that too… nothing!
Nobody should ever be ripped of benzos. That is insanely cruel. Better to never take then regularly in the first place, but only a very slow taper will prevent debilitating withdrawals. If you’ve been taking for years, the taper may need to be over a year.
Who is qualified to dx akithisia? Psychiatrist, neurologist, general practitioner?
All three should be able to diagnose it
@@PsychiatrySimplified 🤣😂🤣 "should" being the operative word
In my experience, not a single healthcare provider out of 10-15 were capable of recognize it ..even when every single symptom including suicidal ideation were present. This is a great time to self diagnose and talk to others who have experienced it. Pacing, rocking foot to foot, shuffling feet, agitation, terror, insomnia, paranoia, suicidal and homicidal ideation.
@@folksongsandflowers6780 yes we all know this now.
Perhaps a neurologist who's willing to tell the truth. That's about it.
How come you advised 5HT2A receptor activation can result in akesthesia but around 16:00 you advised 5ht2a receptor antagonist e.g. mirtazapine is a possible treatment? IS there a difference between the words activation and antagonist?
Also why 15mg of mirtazapine? The usual does is 30-45 mg for depression.
Activation is an agonist effect which means the neuron fires - so 5HT2 A activation can lead to akathisia and anxiety. Mirtazapine is a 5 HT2 A antagonist - antagonist blocks the effect of the neurotransmitter preventing firing of neuron so it reverses activation and can treat akathisia. Hope this helps .
@@James-hq7zh 15 mg has prominent anti histaminergic effect and 5 HT2A antagonist effect. This can be used for akathisia , mild depression with anxiety. At doses of 45-60 mg - Mirtazapine has alpha-2 agonist properties at prestnaptic receptors - this results in an increase in DA and NA in frontal lobe hence can be used in more severe depression. Here is an article covering the mechanisms of AD s in more detail. psychscenehub.com/psychinsights/summary-21-antidepressants-network-metaanalysis/
@@PsychiatrySimplified does increase profontal lobe NA cause an increase in NA across the whole body in some individuals? Or is it localized to the prefrontal cortex?
Also with noradrenaline reuptake inhibitors do they affect the whole body? I definitely felt zyban increased the adrenaline feeling to a full body tingly disgusting and not good feeling with my dex when it first kicks in, and this doesn't happen with just the dex even with the latter doses or higher doses. After I stopped zyban, that feeling went away completely and dex feels completely fine and doesn't make me anxious. Zyban also caused a constant feeling even without the dex of agitation, it was very uncomfortable with a huge rise in anxiety, that was there even when waking and not taking dex for a few days.
@@archades54 noradrenaline has systemic effects as well, besides increase in dopamine in the limbic pathways can increase agitation.
this is the only videos who has antidepressant side effect in the title when talking about these conditions. All others talk about the symptoms and speak about it being a side effect in the video but don't tag as though nobody in their camp is under 30 years old and understand what it is too tag for people looking for #sideeffects #ssri #ssha #antidepressants #psychiatricmedication #benzos #JordanPatterson❓
Makes so much sense. Particularly why Akathisia and restless leg are also a really common symptom of ADHD.
And ADHD theory states it arises out of lack of dopamine in the mesocortical pathway from the VTA to the cortex. And the drugs we use are dopamine agonists. And amphetamine can also act not only as dopamine reuptake inhibitor but also as a dopamine analogue.
I would theorise that methylphenidate and dexamphetamine may also treat akathesia
Akathisia involves an imbalance of NA in the shell vs core nucleus accumbens - this usually occurs in the context of dopamine antagonism. Stimulants aren’t a typical treatment because they would increase NA as well which can worsen Sx.
Does it resolve and do these blocked areas eventually unblock?
Akathisia is treatable.
Does it eventually resolve on its own?
What is your recommendation on treatment? Taking a beta blocker which will eventually then cause heart issues once you go off? Will I have to take the beta blocker forever? I have mental akathisia- not leg movements or other body movements. Thank you.
@@MsMary414 mental akathisia is more likely to be agitation or mixed states - as the definition of akathisia is related to movement as it involves the movement areas of the brain. Beta blockers do not cause heart issues. When prescribed appropriately they can have beneficial effects - this all needs a medical / psychiatric evaluation. Have you had an evaluation?
What is an arousal reduction medication?
There is a hierarchy. Starting from milder agents - benzodiazepines ( short term) , melatonin, Beta blockers moving to alpha 2 agonists ( see video- prazosin, clonidine) to mood stabilisers to antipsychotic medications
@@PsychiatrySimplifiedthanks! Is mirtazapine in the group as well?
it can reduce anxiety via 5HT2A antagonism and some sedative action at low doses but it is better for anxiety not for hyperarousal which is a step above
I'm ready to die. How do I make my voice heard
my Neurologist prescribed vitamin B12 it worked like a magic
Good to know. What was the medication that led to akathisia for you?
i was given depression medication risperidone injections and developed akathisia .withdrew all. and met a neurologist and he prescribed vitamin B 12 .it worked so well . @@PsychiatrySimplified
Can you explain more
You’re saying if you take Latuda and you have Akathisia just add another med like a Benzo? Why aren’t you taking the person OFF the med? Latuda is a horrid drug to come off. I was taken off too fast because I guess my doctor thought I got Akathisia from Latuda. Anyone who says Latuda doesn’t have withdrawal is clearly getting paid to say that.
Hello Doctor,
My question is does acute akathisia resolve " go away " after sometime weeks or months while still on anti psychotics ?
Regards
Yes it can . Dose reduction , medication optimisation and treatment is important . Ps not advice. Your doctor should be able to provide specific advice
@@PsychiatrySimplified
HI doctor
Thank you for your previous reply
I have another question if the brain can self heal then the anti psychotics can be discontinued after a year or 2?
Or does it depend on the triggers and reason and each individual has a different case whether it's drinking, smoking etc?
Isn’t olanzapine a first gaeneration?
Second generation - first generation are D2 antagonists
@@PsychiatrySimplified thank you for putting me right. I’d always thought it was a first generation so never thought to check.
Can Clomipramine cause akathisia?
Yes it can.
@@PsychiatrySimplified What can happen if you come off Clomipramine cold turkey?
Withdrawal is a possibility and relapse of primary symptoms
Not every person gets it from medication. Some people get it from withdrawal and that can end up lasting for years. The “treatments” do not work for me as I got it from being ripped off all my meds which included Benzos and opioids.
Yes akathisia can occur due to withdrawal.
🙌
It is hell.
I tried to suicide due to it.
I lose all the hopes in my life.
I’m sorry to hear that, how are you now?
Same here
YESSS!!!!! MEDICAL MARIJUANA IS KEY TO STOP AKATHISIA!!! AND LITTLE BY LITTLE STOP TAKING THE PILLS THAT CAUSED THIS! THERE'S ALWAYS HOPE. I HAVE HAD AKATHISIA AND YES THERE'S HOPE, YOU'LL BE STRONG LIKE NEVER BEFORE AND ACCOMPLISHED WHAT NEVER BEFORE
?Is it really treated
@@nasal9406 yes but it doesn't benefit the corrupted pharmaceutical companies to tell you. since a plant is not something they can patent as intellectual property
I ready story about Akathisia I want to you to read
@@david97GP At one point, the psychiatrist agreed with some folks on the Living with Akathisia site that a certain strain of marijuana might possibly help. After a few hits, it made Marcello run out into the rain in what looked like a true psychotic break-but was actually the akathisia being severely aggravated by the marijuana. Marcello recently told me that it was the most horrific night thus far, as he’d been filled with powerful urges to kill both his father and himself
@@nasal9406 sure would love to,
Wow azithromycin too? 😬😬😬
Omg this is so mild - my benzo patients are the worst - and they are running around and screaming
Meredith thats my situation now what can be done thanks
6 month or longer
Worst. Thing. Ever.
High fat carnivore diet reversed my life long depression.
These medications just make you sick.
Torture. 40 years ive had it
Medical weed helps, cbd weed helps